Coroner's Finding: CUCUK Radomir

38y · Male·multi organ failure secondary to intestinal ischaemia from toxic megacolon related to severe constipation

A 38-year-old man with chronic schizophrenia died from multi-organ failure secondary to intestinal ischaemia caused by toxic megacolon from severe constipation. He was a detained patient on Clozapine and Oxybutamin, both known to cause constipation. On 6 January 2003, he presented to hospital with abdominal pain and was appropriately transferred to the Royal Adelaide Hospital where imaging confirmed colonic distension. He suffered cardiac arrest while awaiting surgical review and underwent emergency colectomy. Despite appropriate clinical assessment and timely surgical intervention, he died from ischaemic bowel necrosis. The coroner found no grounds for criticism of medical treatment. However, the case highlights the importance of proactive bowel management in psychiatric patients on constipating medications, particularly those with limited ability to self-report symptoms.